According to SAMHSA’s Treatment Episode Data Set (TEDS) from 2011, focusing on detoxification program statistics, 67% of clients completed their detoxification stay, while only about 10% were transferred to further substance abuse treatment.
Without understanding the way the drug treatment system in Massachusetts works, these numbers look and sound fantastic. The majority of clients are completing detox! Don’t get me wrong; completing a five to seven day detox program is great. But what does a detox completion actually mean? Let’s look back to the client that I referred to in part one of this short opioid overdose blog series; he falls into this “completed” category. Let’s call this client “Billy”. He overcame all of the barriers involved in getting into a detoxification program. His insurance covered his entire stay there and did not kick him out halfway through. Billy put the time and effort into securing himself a bed in a program and transportation to that program. Once he got to “Detox A” he suffered through the physical symptoms, and did not get kicked out of the program. Billy did what he was supposed to do and advocated to be transferred to further substance abuse treatment. Unfortunately, there were no beds available, so instead of falling into the “transferred to further treatment” category, he is put in the “completed” category.
Usually to get into a long term residential treatment program, a client must start with a detox. Ideally they are then transferred to “step-down” services, which could include a Clinical Stabilization Service program (CSS) or a Transitional Support Service program (TSS). A CSS usually lasts 10-14 days, while a client could be at a TSS for up to 30 days. From a TSS or CSS clients would be moved to a long-term residential treatment program, which could last anywhere from 3 months to a year. To get into a CSS or TSS from the street can be difficult, especially because staying sober on the street is tough. So the general entry point is through detox. We know that when a person does not use for even three to four days, their tolerance for that primary drug drops and they are at a higher risk for overdose. Looking back at those TEDS report at the top of the page, we now see why these statistics are so alarming. Where are those 67% of people going once they complete their detox program if they are not being transferred to further treatment? This can be an extremely vulnerable time for people who are using drugs, and we are abandoning them.
Governor Patrick and many local politicians are now realizing that opioid addiction and opioid overdose is a problem here in Massachusetts and in the Northeast. Narcan is being provided at detoxification programs, so ideally every client will leave detox with a Narcan kit whether they are going to further treatment or not. But clearly Narcan is not the complete answer to this epidemic. In March of this year, when Governor Patrick declared the overdose problem an epidemic, he also formed an Opioid Task Force. They were charged with the task of investigating why Massachusetts has had so many fatal overdoses, and what recommendations could help address this issue. Yesterday, June 10, 2014, those recommendations were released to Governor Patrick and to the public.
The Task Force keeps their recommendations very vague, but their ideas are good. They recommend:
- New detoxification programs
- Add new and expand on CSS, TSS, and long term treatment programs
- Expanding 8 specialized drug courts for non-violent offenders
- 5 New Opioid Overdose Prevention Coalitions
- Increased pain management training for prescribers
- Central substance abuse treatment navigation system
- Investigate barriers to treatment that involve health insurance company policies
- Enhance substance abuse treatment programs in jails and prisons
- Add a Recovery High School in Worcester area
- Add Learn to Cope chapters across the state
These are just a few of what the Task Force would like to see happen. Readers: what else should be done to decrease the number of opiate overdoses in our home state?
References
Opioid Task Force, Findings of the opioid task force and department of public health recommendations on priorities for investments in prevention, intervention, treatment, and recovery. June 10, 2014. Found on June 10, 2014. http://www.mass.gov/eohhs/docs/dph/substance-abuse/opioid/report-of-the-opioid-task-force-6-10-14.pdf
Department of Health and Human Services: Substance Abuse and Mental Health Services Administration: Center for Behavioral Health Statistics and Quality, Treatment episode data sets (TEDS), 2011: Discharges from substance abuse treatment services. (2011). Found on June 8, 2014. http://samhsa.gov/data/2K14/TEDS2011DS/TEDS2011DIndex.htm
For Help Finding Treatment:
- PAATHS (Providing Access to Addictions Treatment and Hope): 774 Albany Street Boston, MA 02118 617-534-5108
- AHOPE Needle Exchange Program: 774 Albany Street Boston, MA 02118 617-534-3976
- Bureau of Substance Abuse Services Hotline: 1-800-327-5050 (Toll free) or TTY 1-888-448-8321 (Toll free)